Medicine/neuro Flashcards
Cerebellar signs
- (Truncal ataxia)
- Broad based ataxic gait
- Rhomberg positive
- Nystagmus
- (Saccades)
- Past pointing
- Dysphonia/Sticato(british constitution)
- Dysdiadochokinesia
- Rebound phenonemon
- (Pronator drift)
- Hyperreflexia
- Hypotonia
- Heel to shin coordination impairement
Brief causes of cerebellar disease
- MS
- Alcohol
- Vascular
- Inherited
- Space occupying lesion
(MAVIS)
Summary of TACI, PACI, Lacunar, POCI (Full NCs under Medicine/Stroke)
- TACI
- Hemiplegia
- Homonymous hemianopia
- Higher corticol dysfunction
PACI - 2 of 3
- Lacunar
- Hemi-motor or hemi-sensory deficit only
- POCI
- Visual fields affected
Define:hemiparesthesia,Hemiparesis and hemiplegia
Hemiparesthesia - altered sensation on one half of the bodyHemiparesis - weakness on one half of the bodyHemiplegia - paralysis of one half of the body
Explaining MS to a patient
- Multiple sclerosis (MS) is a condition that can affect the brain and/or spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation or balance.
- Autoimmune conditionwhere the body attacks the coating of nerves
- It’s a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
- In many cases, it’s possible to treat symptoms. Average life expectancy is slightly reduced for people with MS.
Risk factors for MS
- 20-30 years old
- Female
- FHx
- Infections such as EBV
- Caucasian
- Autoimmune PMHx e.g. hypothyroid, DM I etc.
Common presentations of MS
- double or blurred vision
- numbness, weakness in one or two extremities
- instability in walking
- tremor
- problems with bladder control
- heat intolerance
Types and brief definition
Relapsing remitting 80% of cases Episodes/attacks of MS lasting days or weeks that may fully recover or leave patient with permanent problems May turn into 2ary progressive Primary progressive 10% of cases Slow progression of sx without remission, though may have ‘stable’ phases 2ary progressive Half of people with relapsing and remiting will develop this Starts as relapsing and remiting then turns into a progressive picture
Investigations of suspected MS
- Refer to neuro
- 2 attacks - soft
- Full neuro exam
- MRI
- Evoked potential test (EEG with eye test)
- Lumber puncture looking for auto-immune antibodies
- Bloods - to rule out other things
Differentials of MS
- Stroke
- Toxins
- B-12 deficiency
- Space occuping lesion
- Other inflammatory disorders like lupus
- HIV
- Vasculitis
Treatment of MS
- LEMONS (lifestyle, education, monitor for complications, nutrition) Treat relapses
- Steriods (pred) reduce length
- Baclofen for mm spasms Prevent relapses
- Disease modifying drugs e.g. interferon beta, alemtuzumab Treat symptoms
- MDT
Circle of willis
Bells palsy features, causes, treatment
Bell’s Palsy (LMN) - temporary palsy of facial nnFeatures - same side as lesion
* Unilateral facial weakness incl forehead
* Bell’s sign (eye rolls upward when trying to close eyelids)
Causes
* Herpes (Ramsay-hunt syndrome vesicles in ear)
* HIV
* Sarciod
* EBV
* Lymes disease
Treatment
* Eye protection - drops, patch
* Prednisone
Other LMN CN7 palsy causes and associated features
Acoustic neuroma - CN5,6+8involvementParotid tumour/ectomy - parotid lump/scarCholesteatoma - CN8 involvementAll features will be same side as lesion
UMN CN7 palsy features, causes and associated sx
Features
* Forhead sparing
* Opposite side to lesion
Causes
* Stroke - hemianopia, hemiparasis/stesia, high cortical dysfunction
* MS - multiple neuro foci e.g. vision problems, sensory and motor issues, bladder problems
Horners syndrome causes, sx, investigation
Horners syndrome - Damage to sympathetic chain that supplies faceCauses * Tumours (thyroid, brain, pancoast) * MS * Trauma e.g. thyriodectomy * Cervical rib * Migraine * Carotid aneursym/dissection * Otitis media Features - all on sameside as lesion * Ptosis * Anhydrosis (no sweating) * Miosis (contracted pupil) Diagnosis * No reaction to cocaine eye drops, normally dilates Investigation Identify cause * MRI - Ca * Carotid USS - carotid pathology * CXR - pancoast
Motor neurone disease: presenting sx/ RF
MN disease - degeneration of motor neuronesPresenting sx * Limb weakness * Slurred speech * Weak grip * MM cramps and fasiculations * Wgt loss * Laughing and crying at inappropriate times * FHx * Age <70
Parkinsons: Triad
Parkinsons - Death of dopinergic nerves in basal gangliaTriad (assymetrical)
- Bradykinesia
- Resting tremor
- Cog wheel rigidity
PD B symptoms
ASSYMETRICAL
- Shuffling gait, limited arm swing, hesitation when starting and turning
- Expressionless face
- Slurred/slow/monotonous speech
- Positive glabellar tap
- Anosmia
- Balance problems
- Urinary/sexual dysfunction
- Visual problems
- Swallowing issues
- Insomnia
- Micrographia
PD investigations and treatment
Investigations * Full neuro exam * Refer to specialist Treatment * MDT * LEMON * L-Dopa
PD plus syndromes and associated features
- Multi-system-atrophy - Low BP/postural hypotension
- Progressive supranuclear palsy (PSP) - Palsy of eye movement
- Corticobasal degeneration - apraxia, acalculia, myoclonus
- Lewy body dementia - dementia
Peripheral neuropathy definition and examples
Peripheral neuropathy - damage to nns of peripheral nervous systemExamples
- Foot drop - common peroneal nn
- Diabetic - polyneuropathy
- Carpal tunnel syndrome - median nn
- Bell’s palsy - CN7
Myopathy definition and examples
Myopathy - disease in which mm fibres don’t work properlyExamples
- dermatomyositis - autoimmune condition that attacks skin and mm
- polymyositis - inflammation of mm
- myositis ossificans - mm turns into bone when injured
Spinal cord stenosis: signs and sx, investigation, causes, treatment
Spinal cord stenosis - narrowing of spinal canal leading to pressure on spinal cord and nn roots. Can lead to cauda equinaSymptoms * Posterior back and leg (both) pain can also be: numbess, weakness, stiffness or parasthesia (pins and needles) * Variable exercise tolerance day to day * Sx relieved by bending forward or sitting down (shopping trolley) Signs * Men * Lumbar * Variable hyporeflexia * Normal strength and sensation Investigation * CT Causes * OA * Disc degeneration * Pagets disease * Thick spinal ligaments * Previous spinal trauma Treatment * Physio - exercise bike * Surgery if bad - laminectomy * Analgesia
Cauda equina: signs and symptoms, causes, investigation, treatment
Cauda equina - compression of cauda equina L2 downSigns * Leg weakness * Reduced anal tone and sensation * Urine retention check with catheter Symptoms * Saddly anaesthesia * Severe lower back pain * Urinary and bowel problems - retention/incontinence of either * Leg pain/weakness/parasthesia bilateral Causes * Central disc herniation * Spondylosis * Spinal stenosis * Tumour * Trauma * Infection Investigation * Emergency MRI of lumbar spine Treatment * Admit * Decompress - surgery * Analgesia
Disc herniation - signs and symptoms, causes, investigation, treatment
Disc herniation - interverterbral disc prolapse leading to pressure on nerve rootsSigns * Decreased power, sensation, reflexes Symptoms * Lumbar * Severe back pain, made worse by moving, bending forward, coughing, sitting, lateral flexion * Radiculopathy * Parastesia * Weakness * Leg pain * Back mm spasm Causes * Age/degeneration * Lifting excess wgt * Excessive excerise * Obesity Investigation * Spurlings, femoral nn stretch, straight leg raise * PNS Treatment * Analgesia * Mm relaxants * TCA * Gabapentin * Rest
Cervical myelopathy: signs, symptoms, causes, investigation, treatment
Cervicalmyelopathy - compression of cervical spinal cordSigns * Weakness and wasting of hand mm * Hypereflexia * Clonus/Hofmans/Babinskis * Normal sensation Symptoms * Progressive * Weakness * Arm, neck and leg pain * Problems with fine motor Causes * Cord compression (tumour, disc herniation etc.) * Ischaemia from vascular compression * Osteophytes Investigation * C-spine x-ray - osteophytes * MRI - canal stenosis, cord anomalies Treatment * Depends on cause * Conservative: physio * Surgery for pain and progressive sx
Radiculopathy: signs, symptoms, causes, investigations, treatment
SciaticaSigns * Leg pain * Radiates below ankle * Positive SLR Symptoms * sharp + shooting (worse w/ cough/sneeze) * altered sensation * reduced power corresponding myotone * absent/reduced reflexes * later muscle wasting/fasiculations Causes * Prolapsed Intervertebral disc * Spinal stenosis * Cauda equina syndrome * Facet arthrosis Investigations Differentiate referred pain from nerve root pain Referred pain * Dull Poorly localised * may affect both legs nerve root pain * sharp well localised * closely follows dermatone * paraesthesia may be present * positive SLR Treatments * Physiotherapy and education * Nerve root block * Epidural steroid injection * Foraminal steroid injection * Surgical decompression
What is the difference between myelopathy and radiculopathy
Myelopathy - compression of spinal cordRadiculopathy - compression of nerve root
Define:Osteophytes, spondylosis, spondylolysis and spondylolisthesis
osteophytes -bony projection associated with the degeneration of cartilage at jointsspondylosis - umbrella term for spine degenerationspondylolysis - stress fracture inpars interarticularis (pointy bit of vertebrae)spondylolisthesis - Slippage of vertebrae from stress facture above
what is the difference betweenbulbar and pseudobulbar palsy
bulbar palsyis a lower motor neuron lesion of cranial nerves 9, 10and 12. Apseudobulbar palsyis an upper motor neuron lesion of cranial nerves 9, 10and 12
